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What is the optimal timing for mitral regurgitation in heart failure?
Valve disease
Interview
Mitral regurgitation in heart failure remains a complex therapeutic challenge, where timing of intervention is as critical as the choice of treatment.
The 2025 ESC guidelines introduced a recommendation for transcatheter edge-to-edge repair (TEER) in patients with ventricular secondary mitral regurgitation who remain symptomatic despite optimised therapy, while evidence for atrial functional mitral regurgitation remains more limited.
In this interview, Frederik Verbrugge and Yohei Ohno discuss what “optimisation” truly means in daily practice. Beyond the four pillars of guideline-directed medical therapy, optimisation includes cardiac resynchronisation when indicated, rhythm control strategies, and adequate decongestion guided by haemodynamic assessment.
They also emphasise that TEER can serve as both a corrective and enabling intervention, improving haemodynamics and allowing subsequent intensification of heart failure therapy when medical options alone reach their limits.
